“There’s plenty of room for all Alaska’s animals – right next to the mashed potatoes.” — Sarah Palin in Going Rogue

Going Rogue: An American Life By Sarah Palin. Harper, 413 pp., $28.99.

By Janice Harayda

How desperate was John McCain to rein in Sarah Palin during his failed bid for the U.S. presidency? On the evidence of Going Rogue, desperate enough that a campaign strategist wanted to fly in a nutritionist who would force Palin to go off the Atkins diet and eat only “meals balanced in carbohydrates and nitrates” to see if it would help her stick to the script.

Like much else in this memoir, this anecdote — if true — shows how bizarre American political campaigns have become. But Palin gives such a loopy and self-serving account of the incident that her words are hard to credit fully. She says she wasn’t on the Atkins diet and had no idea why the strategist wanted to hire a nutritionist: “The Atkins bars – that must be it. They were everywhere, in every hotel room and on every snack table along the train. They were great when I didn’t have time to slow down and eat, but I didn’t know why they were all over the place.”

Maybe Palin didn’t know why the bars were everywhere. But something was apparently behind the incident that she can’t or won’t admit. And Going Rogue has so many such one-sided or off-kilter stories – some involving far more serious issues — that a better title for the book might have been: Spin, Baby, Spin.

With help from the writer Lynn Vincent, Palin gives a colorful account of a childhood that involved eating caribou lasagna and using wooden sidewalks in a frontier community that got television shows on a one-week delay. And she suggests why her state remains unique: “You know you’re an Alaskan when at least twice a year your kitchen doubles as a meat-processing plant.”

But Palin also engages in the same kind of backstabbing she says she faced during the campaign. And she saves some of her most cynical and sarcastic comments for McCain staff members, who she believes failed to appreciate what she could contribute even as they raised her from obscurity to a fame that enabled her to receive a reported $5 million advance for this book. Nancy Pelosi writes in her memoir Know Your Power that she got valuable advice from the former Congresswoman Lindy Boggs of Louisiana, who told her: “Never fight a fight as if it’s your last one.” If Pelosi and Boggs are right, Going Rogue bodes poorly for any national political ambitions held by its author: In this book Palin fights as though it were her last fight.

Best line: No. 1: “I always remind people from outside our state that there’s plenty of room for all Alaska’s animals – right next to the mashed potatoes.” [cq “all animals.”] “In Alaska, we joke that we have two seasons: construction and winter.”

Worst line: No. 1: “But when the boom went bust, the golden goose still ruled the roost.” No. 2: On how she won the Miss Wasilla pageant, which included a swimsuit competition: “Then I shocked my friends and family, put on a sequined Warrior-red gown, danced the opening numbers, gave the interview, and uncomfortably let my butt be compared to cheerleaders’ butts.” No. 3: “I breathed in the autumn bouquet that combined everything small-town America with rugged splashes of the Last Frontier.” No. 4: On her lack of freedom as the vice-presidential nominee: “But now I felt like a bit of a captive, pulled away from my loved ones in favor of a ‘higher priority,’ as though in the final analysis there is any such thing.”

Wonder why some residents of New Jersey weren’t surprised when law-enforcement authorities arrested dozens of people Thursday in a political corruption and money-laundering probe that involved rabbis, mayors and a defendant said to have stuffed $97,000 in cash in a box of Apple Jacks? Read Jon Blackwell’s Notorious New Jersey: 100 True Tales of Murders and Mobsters, Scandals and Scoundrels (Rutgers University Press, 2007). This lively book looks back on sordid events in Garden State history from the 1804 Aaron Burr-Alexander Hamilton duel in Weekhawken to the 2002 murder conviction of the philandering Cherry Hill rabbi Fred Neulander. Blackwell argues that crime thrives in New Jersey because, with 566 municipalities, the state has “many nooks and crannies where bribery can flourish.” That’s true as far as it goes, but former Star-Ledger reporter Brad Parks offers a fuller explanation in his “Poison Ivy in the Garden State” in the July 25–26 Wall Street Journal. A review of Notorious New Jersey appeared on October 20, 2008.

It’s flu season, and that’s bad news for you if you have an obscure disease with flu-like symptoms. Your doctors’ diagnoses might reflect a confirmation bias (a tendency to find what they expect to find), an availability error (a decision based on how easily examples come to mind) or other cognitive flaws that Jerome Groopman describes in this engaging bestseller.

Groopman’s thesis is that a doctor’s state of mind strongly affects clinical decision-making. And many of his examples are eye-opening if paradoxically commonsensical. Do doctors’ friends get better care? Not necessarily, Groopman says. A doctor might hesitate to prescribe a necessary but painful test for a friend. Do doctors favor the sickest patients, who may need their care the most? Actually, they prefer healthy ones. One social psychologist found that “the sickest patients are the least liked by doctors, and that very sick people sense this disaffection,” Groopman writes. Apparently many doctors feel they have worked in vain when a disease resists treatment and stop trying to help.

Much of this is so interesting that you wish this book didn’t reflect biases of its own. One is that it slights mistakes that result from factors other than cognitive flaws, such as fatigue, poor training and inadequate supervision. “Experts studying misguided care have recently concluded that the majority of errors are due to flaws in physician thinking, not technical mistakes,” writes Groopman, a professor at Harvard Medical School and staff writer for The New Yorker.

But when you go to the end notes of his book to look for the source of that hard-to-believe “majority,” you read: “Although the frequency of misdiagnosis has been studied, few researchers have focused on its relationship to physician cognition.” So who are those “experts” who found that most errors result from doctors’ thinking?The notes name only one expert who found such a “majority,” a researcher who had studied “serious errors that led to malpractice claims.” But Groopman says that the majority of all errors result from physicians’ thinking, not the majority of errors that lead to malpractice suits. Either his end notes are incomplete or he misrepresents in the book some of the material he cites in the notes.

At the very least How Doctors Think leaves a different impression of the causes of mistakes than the chapters on medical errors and problem doctors in Atul Gawande’s Complications, a more cogently argued book by another physician who writes for The New Yorker. Gawande quotes from a landmark series of papers in the New England Journal of Medicine that reported that one percent of all hospital admissions involved negligence that prolonged the stay or led to death or disability of the patient. A smaller study of the treatment of cardiac arrests found that “27 of 30 clinicians made an error in using the defibrillator – charging it incorrectly or losing too much time figuring out how to work a particular model.”

Groopman is a bit like a coach who blames the problems in baseball on the character flaws of individual players instead of the culture that produced them. He says that doctors “desperately” need patients to “help them think.” If that’s true, it reflects badly on the entire American system of medical education, training and certification, not just on individual physicians. Clearly many doctors need more than “help” thinking logically – they need to learn how to work the defibrillator.

Best line: “When a patient tells me, ‘I still don’t feel good. I’m still having symptoms,’ I have learned to refrain from replying, ‘Nothing is wrong with you.’ The statement ‘Nothing is wrong with you’ is dangerous on two accounts. First, it denies the fallibility of all physicians. Second, it splits the mind from the body. Because sometimes what is wrong is psychological, not physical. This conclusion, of course, should be reached only after a serious and prolonged search for a physical cause of the patient’s complaint.”

Worst line: Groopman says his book is for people who aren’t physicians “because doctors desperately need patients and their families and friends to help them think.” Isn’t it bad enough that we have all those TV commercials telling us to ask our doctors if we need a certain drug because, basically, they’re too dumb to figure it out on their own? Do we need this kind of smarm from doctors, too? Groopman doesn’t mention that there are 285 doctors for every 100,000 people in the U.S. and, if he’d written his book for doctors, he might make a lot less money.

Recommendatiom? A good but one-sided book. If you’re interested in medical errors, consider reading the chapters called “When Doctors Make Mistakes” and “When Good Doctors Go Bad” in Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science (Holt/Metropolitan, 2002) www.gawande.com instead of or in addition to How Doctors Think.

One-Minute Book Reviews is for people who like to read but dislike hype and review inflation. It is also for people who dislike long-winded weasel reviews that are full of facts and plot summaries but don’t tell you what the critic thought of the book.

Entertainment Weekly named Mitch Albom’s For One More Day one of the five worst books of 2006, but that novel almost looks like a neglected masterwork next to some of the titles on this year’s list. They are:

If I Did It (O.J. Simpson’s name was removed from the cover of this one.)